"LSD to Cure Depression? Not So Fast"
By Richard A. Friedman
For the New York Times (editorial)
Psychedelics, the fabled enlightenment drugs of the ’60s, are making a comeback — this time as medical treatment.
A recent study claimed that psilocybin, a mushroom-derived hallucinogenic, relieves anxiety and depression in people with life-threatening cancer. Anecdotal reports have said similar things about so-called microdoses of LSD.
The allure is understandable, given the limits of our treatments for depression and anxiety. About a third of patients with major depression don’t get better, even after several trials of different antidepressants. But I fear that in our desire to combat suffering, we will ignore the potential risks of these drugs, or be seduced by preliminary research that seems promising.
This appears to be the case with the new psilocybin study, which has some serious design flaws that cast doubt on the results (and which the authors mention briefly). The study, done at New York University School of Medicine, examined a very small number of people with cancer in a “crossover” design in which each subject served as her own control, sequentially receiving doses of psilocybin and the control drug niacin, in random order. (Another recent study of psilocybin, done at Johns Hopkins University, used a similar crossover design.)
The fad of LSD microdosing — typified by Ayelet Waldman’s new memoir, “A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage and My Life” — is far more worrisome. LSD is an unregulated and superpotent drug; users cannot be sure what or how much they are actually taking.
The bottom line is that we don’t know how safe or effective psychedelics are because most of the data have been anecdotal or from small trials. Part of the reason is that hallucinogens have been classified as Schedule I drugs, the most restrictive category, reserved for drugs considered to have no legitimate medical use and to have a high abuse potential. This makes it somewhat difficult for researchers to conduct large studies, but it is by no means an absolute bar; there are many trials of Schedule I drugs like THC and cannabinol, active molecules in marijuana.
I am anxious that we do not repeat the mistake that we made with cocaine. Aside from Freud’s glowing 1884 monograph on cocaine, “Über Coca,” in which he described his research on cocaine — and his addiction to it — there was little modern research on the drug. In the ’70s and ’80s, people assumed that the absence of data that cocaine was addictive meant that it was safe and dismissed concerns as hysterical moralizing. An epidemic followed.
Psychedelic drugs don’t come close to the toxicity or abuse potential of cocaine. But we can’t assume they are perfectly safe just because we don’t yet have serious evidence of harm.
Psychedelics might turn out to have real promise, but that needs to be proven through large, rigorous, placebo-controlled trials. We’re not there yet.
Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College
This assessment is annoying, but look at that last part: it basically calls for the next step in the research--a step forward.
Edited by Sidestreet, 13 February 2017 - 06:52 AM.